Promotion of Para athlete well-being in South Africa (the PROPEL studies): Profiles and prevalence of psychological distress

Mental health of young talented football players in an African context: A cross-sectional observational study

BACKGROUND

Elite sport is a potentially pathogenic environment due to stressors like dual-career, high training demands, and performance pressure. Recent evidence suggests that athletes are at high risk of mental health issues. Even though the FIFA is increasingly paying attention, efforts directed towards young talented footballers are scarce. Few studies have even been conducted on young talented footballers in Africa. The majority of epidemiological studies on athletes also suffer from an analytical approach that does not highlight athletes' mental health profiles. This study aims to describe the mental health profile and their prevalence of young talented footballers in three African representative countries.

METHODS

The study applied an observational-based cross-sectional research design with aspiring footballers from three sub-regions of Africa and aged between 10 and 23. The data was collected face-to-face from March to November 2022. Three screening tools were used to measure three mental health outcomes: Satisfaction With Life Scale (subjective well-being), Patient Health Questionnaire 9-item (depression), and Generalized Anxiety Disorder 7-item scale (anxiety). The mental health outcomes were rates and scores of well-being, depression, and anxiety, used in latent profile analysis.

FINDINGS

507 male young talented footballers (263[51∙9%] Cameroonians, 73[14∙4%] Moroccans, and 171[33∙7%] Ivorians) were included in the analysis with a mean age of 15∙1 (SD 2∙37) years. Screening of mental health states revealed that 367(72∙3%) and 412(81∙8%) of these players experienced anxiety and depressive symptoms respectively and 155(30∙7%) experienced low well-being. Differences in mental health outcomes were noted between countries, age groups and competition levels. Three profiles of mental health condition were also identified, namely moderate mental health (Profile 1), languishing (Profile 2) and flourishing (Profile 3).

INTERPRETATION

The youth of football academies in the three African countries studied have a specific mental health profile, revealing a high prevalence of common mental disorders in the African context. These findings underline the need to enhance the awareness of mental health issues in young African players and provide tailored support.

FUNDING

FIFA.

Evaluating workforce needs: an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of Para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games

OBJECTIVES

To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games.

METHODS

A cross-sectional observational study was conducted. National Paralympic Committee's HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics.

RESULTS

The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes.

CONCLUSION

HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.

Athlete Identity, Resilience, Satisfaction with Life and Well-Being of Para Badminton Players: A Multinational Survey

Objective

To explore regional differences (i.e. Europe, Asia and others) in the well-being of para-athletes and its potential psychosocial determinants, including the Athletic Identity Measure Scale (AIMS), the Brief Resilience Scale (BRS) and the Satisfaction with Life Scale (SWLS).

Methods

The study was a cross-sectional survey using data from multinational badminton federations. The study participants were athletes registered in the Para Badminton Classification Master List of the Badminton World Federation (BWF). The main study outcome is the WHO Quality of Life-Disability Questionnaire (WHOQOL-DIS).

Results

There were 1,385 (aged 36 years old, IQR 18 years old) registrants on the master list. Respondents totaled 170. Only 137 (65% were males) were included in the analysis after excluding those with missing data (Europe 40%, Asia 30%, others 30%). Following the results of factor analysis, the original Athletic Identity Measure Scale (AIMS) was separated into self-identity (SI) and AIMS-modified. SI, AIMS-modified, the BRS and the Satisfaction with Life Scale (SWLS) were all scored above average. The AIMS-modified scores of Europeans were significantly lower than those of other non-Asians (U = 757.000, P < 0.05). BRS was statistically higher among those with acquired disabilities (median: 3.33) compared to those with congenital disabilities (median: 3.0) (U = 1,717.000, Z = -2.711, P < 0.05) and among Europeans (median: 3.3) compared to Asians (median: 3.0) (U = 704.500, P < 0.05). The regression model explained 32% of the variability in quality of life (QOL) with five significant predictors. The SWLS (β = 0.307, P = 0.01), BRS (β = 0.269, P = 0.01), full-time employment (β = 0.191, P = 0.05) and being female (β = 0.162, P = 0.05) all had a positive effect on QOL, but not the AIMS (-0.228, P = 0.05).

Conclusion

The results show that the athletes' resilience, satisfaction with life and identity vary across regions. Furthermore, satisfaction with life, employment and gender were found to be significant predictors of athletes' QOL.

Promotion of Para Athlete Well-being (PROPEL II): A Cross-sectional Study of Sleep in Para Athletes Across Two Nations

OBJECTIVE

Limited research exists on the sleep profiles of South African Para athletes. The aims of this study are to describe sleep quality, day-time sleepiness, and chronotype of South African Para athletes and to compare the relationship between sleep-related outcomes and demographic factors to athletes from a higher-resource country.

DESIGN

A descriptive, cross-sectional survey was conducted. Sleep-related characteristics were assessed with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire. Multiple regression models were run with and without country as independent variable.

RESULTS

One hundred twenty-four South African athletes and 52 Israeli athletes were included. Thirty percent of South African athletes presented with excessive daytime sleepiness, 35% slept 6 hrs or less per night, and 52% reported poor sleep quality. Thirty-three percent of Israeli athletes reported excessive daytime sleepiness, 29% slept 6 hrs or less, and 56% reported poor sleep quality. Chronotype was the only variable that differed significantly between countries (overrepresentation of morning types in South African athletes, and intermediate types in Israeli athletes). Intermediate chronotypes had significantly greater odds of excessive daytime sleepiness ( P = 0.007) and poor sleep quality ( P = 0.002) than morning types, irrespective of country.

CONCLUSIONS

The high prevalence of poor sleep among both South African and Israeli Para athletes warrants further investigation.

Validation of the Patient Health Questionnaire-4 for longitudinal mental health evaluation in elite Para athletes

BACKGROUND

Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented.

OBJECTIVE

Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes.

DESIGN

A 43-week prospective observational cohort study.

SETTING

Online questionnaire, provided weekly via web browser and mobile app.

PARTICIPANTS

Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Weekly PHQ-4 scores, stress level, and mood.

RESULTS

With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1-1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p < .001). Internal consistency of the PHQ-4 was satisfying, Cronbach's α being 0.839. There were significant cross-sectional as well as longitudinal correlations of PHQ-4 and stress level as well as mood values (p < .001). 39.7% of all athletes (n = 31) had at least one positive screen for mental health symptoms.

CONCLUSIONS

The PHQ-4 was shown to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ-4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow-up.

Getting psyched up: Developing the field of Sport and Exercise Psychiatry in South Africa

Elite athletes and their entourage are exposed to intense stressors and commonly experience mental health symptoms and disorders. While there is limited literature on prevalence rates in a South African setting, initial data show that both current and retired athletes may experience these symptoms, but with low treatment rates. There is a need to improve mental health literacy and mental health care in athletes. Athletes may benefit from systematic mental health surveillance and additional screening during high-risk periods, such as injury or retirement. This commentary brings athlete mental health into focus and advocates for the inclusion of sport and exercise psychiatry into the athlete entourage and broader mental health team, in order to close the treatment gap. We provide seven recommendations for the initial way forward for sport and exercise psychiatry in South Africa.